| NPI | 1649539941 |
|---|---|
| Entity Type | Individual |
| Gender | Male |
| Sole Proprietor ? | No |
| Primary Taxonomy | 1041C0700X Social Worker, Clinical (Licence: NC C009580) |
| Additional Taxonomies | 104100000X Social Worker (Licence: WA SA 60256227) |
| Enumeration Date | 2012-05-08 |
| Last Update Date | 2016-03-25 |